What to Expect on Your First Visit

The initial appointment is devoted to you talking about your needs and concerns. During this appointment it is also helpful to discuss you as a person and other things that have been going on in your life. By the end of the initial consultation your psychologist will aim to provide you with feedback about your main problem and suggest therapy approaches which may assist to resolve or reduce your main difficulty. Another aim is to identify a set of goals to work towards. The usual course of events is that we make a second appointment, at which time we might be able to start some intervention and continue the...

New Appointments with our Clinical Psychologists

To make an appointment all you need to do is contact us on (02) 9889 4290. The first appointment goes for approximately 1-1.5 hours. You don’t need a referral to make an appointment. Many people refer themselves and come without a letter of referral. However, it can be helpful if you get a referral from your GP or another health professional before coming along. Medicare rebates are available when you have a mental health care plan by your GP. If you are unsure about whether or not a Clinical Psychologist will be able to help, please give us a call or send us an email and we will get in touch with you and answer any questions you may...

What is Dialectical Behaviour Therapy?

Dialectical behaviour therapy (DBT) is a psychosocial treatment developed by Marsha M. Linehan specifically to treat Borderline Personality Disorder. While DBT was designed for Borderline Personality Disorder, it can also be used with people experiencing a range of emotional and behavioural difficulties including depression and anxiety. The treatment itself is based largely in behaviourist theory with some cognitive therapy elements as well. There are two essential parts of the treatment, and without either of these parts the therapy is not considered “DBT adherent”. 1. An individual component in which the therapist and client discuss issues that come up during the week following a treatment target hierarchy. Self-injurious and suicidal behaviours take first priority, followed by therapy interfering behaviours. Then there are quality of life issues and finally working towards improving one’s life generally. During the individual therapy, the therapist and client work towards improving skill use. Often, skills group is discussed and obstacles to acting skilfully are addressed. 2. The group, which ordinarily meets once weekly for about 2-2.5 hours, in which clients learn to use specific skills that are broken down into 4 modules: core mindfulness skills, emotion regulation skills, interpersonal effectiveness skills and distress tolerance skills. The Four Modules Mindfulness The essential part of all skills taught in skills group are the core mindfulness skills. Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?” Non-judgmentally, One-mindfully, and Effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?” Interpersonal Effectiveness Interpersonal response patterns taught in DBT skills training...

What is Acceptance and Commitment Therapy?

What is Acceptance and Commitment Therapy? The general goal of ACT is to increase psychological flexibility – the ability to contact the present moment more fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends. Psychological flexibility is established through six core ACT processes. Each of these areas are conceptualised as a positive psychological skill, not merely a method of avoiding psychopathology. Acceptance Acceptance is taught as an alternative to experiential avoidance. Acceptance involves the active and aware embrace of those private events occasioned by one’s history without unnecessary attempts to change their frequency or form, especially when doing so would cause psychological harm. For example, anxiety patients are taught to feel anxiety, as a feeling, fully and without defense; pain patients are given methods that encourage them to let go of a struggle with pain, and so on. Acceptance (and defusion) in ACT is not an end in itself. Rather acceptance is fostered as a method of increasing values-based action. Cognitive Defusion Cognitive defusion techniques attempt to alter the undesirable functions of thoughts and other private events, rather than trying to alter their form, frequency or situational sensitivity. Said another way, ACT attempts to change the way one interacts with or relates to thoughts by creating contexts in which their unhelpful functions are diminished. There are scores of such techniques that have been developed for a wide variety of clinical presentations. These techniques attempt to reduce the literal quality of the thought, weakening the tendency to treat the thought as what it refers to (“I am no good”) rather...

What is Cognitive Behaviour Therapy?

Psychotherapy is a form of treatment for emotional and psychological problems where a person talks with a mental health professional such as a psychiatrist, psychologist or counsellor. Cognitive behaviour therapy (CBT) is a form of psychotherapy that helps a person to change unhelpful or unhealthy thinking habits, feelings and behaviours. CBT involves the use of practical self-help strategies, which are designed to bring about positive and immediate changes in the person’s quality of life. CBT is used to treat a range of psychological problems including: Anxiety Anxiety disorders such as social phobia, obsessive-compulsive disorder or posttraumatic stress disorder Depression Low self-esteem Uncontrollable anger Irrational fears Hypochondria Substance abuse, like smoking, drinking or other drug use Eating disorders Insomnia Marriage or relationship problems Certain emotional or behavioural problems in children or teenagers. CBT is also used to help many more psychological problems. In some cases, other forms of therapy used at the same time may be recommended for best results. The core philosophy of CBT is that thoughts, feelings and behaviours combine to influence a person’s quality of life. For example, severe shyness in social situations (social phobia) may stem from the person thinking that other people will always find them boring or stupid. This automatic belief causes the person to feel extremely anxious at social gatherings. Their behaviour may include stammering, sweating and other uncomfortable symptoms. The person then feels overwhelmed with negative emotions (such as shame) and negative self-talk (‘I’m such an idiot’). Their fear of social situations may become worse with every bad experience. CBT aims to teach people that it is possible to have control over...

What do I do if a family member/friend needs help?

You can help them gather information about the support that is available for them to access. Ultimately they will need to be spoken to directly by the therapist and they will need to consent to therapy. Some helpful things to keep in mind as a support person: Ask them directly how they wish to be supported. Sometimes our ideas of what is helpful for a person may not be a good fit with the person who requires the support. Taking the time out to understand the condition they are dealing with can be helpful. However, it is often said that unless a person has experienced a particular illness, they are limited in their ability to understand the full extent of the experience. Stick by them through thick and thin! Though the person suffering from mental illness will fluctuate in their experiences and at times may want to withdraw from those they care about, they will always value and benefit from family and friends who care for them unconditionally. Finally, as a carer, make sure you look after your own health as you care for others. You will only be able to do a good job as a carer when you are cared for...

What do I need to do if I want to make an appointment?

Usually it is preferable to get a referral from your GP or a psychiatrist before your first appointment, however this is not always necessary. If you seek treatment under the Better Access to Mental Health scheme, you will require a mental health care plan (i.e. a detailed mental health assessment) from your GP first or a written referral from your psychiatrist or paediatrician before you are able claim a medicare rebate. The mental health care plan may require a longer session with your GP and it may be helpful to check beforehand whether your GP is able or willing to conduct one. The Better Access to Mental Health Care scheme was introduced by the Australian government in November 2006. Under this scheme all registered psychologists endorsed by Medicare Australia are able to provide treatment for mental health problems whereby the client is able to claim a medicare rebate. Currently, clients who are seen by a registered specialist clinical psychologist are able to claim back a rebate of $124.50 per session for a 50+ mins consultation for up to 10 sessions per calendar...

What are “evidence-based” treatments?

The term “Evidence-Based Treatments” refers to treatments that have undergone controlled research studies, the results of which inform decisions regarding treatment approaches that the therapist should adopt. There are existing treatment approaches which have not undergone adequate research and therefore are not considered “evidence-based”. Evidence-Based Treatments used by Clinical Psychologists Psychologists & Clinical Psychologists attempt to adopt only evidence-based therapies in treatment. The most well known of these are Cognitive Behavioural Therapy and Interpersonal Psychotherapy. More recently, there has been growing interest in an approach known as “Acceptance & Commitment Therapy” and Mindfulness-based therapies. They are in their infancy with regards to treatment outcome studies but the initial results are promising! For a brief summary of each approach, see below. Cognitive Behavioural Therapy (CBT): This is a time-limited therapy approach which explores the thoughts and feelings that arise in response to various situations or events. It encourages people to examine and challenge unrealistic thoughts and assumptions by exploring alternative explanations and considering the evidence for thinking particular thoughts (e.g. if I hear a noise and automatically assume that it must be a thief, thereby provoking anxious feelings what could be an alternative explanation?). The goal is to work towards an alternative response (thought & action) that is more helpful and realistic. The premise is if we are able to achieve this, then this will help to improve our emotional experience. Studies have shown CBT to be effective in the treatment of depression, anxiety, eating disorders, relationship problems and anger. Interpersonal Therapy (IPT) is a form of therapy that emphasises the centrality of relationships in understanding conditions such as depression...

What is the difference between a psychologist and other mental health professionals?

People often ask what the difference is between a psychologist and other mental health professionals. Here is a summary of the differences: Psychiatrist: A psychiatrist is a medically trained doctor who then specialises in the area of psychiatry. Psychiatrists are responsible for determining whether a person requires an admission to hospital, formal diagnosis and prescription of medication. Psychologists & Clinical Psychologists adopt a research-oriented approach in their practice. They assist people with assessment, diagnosis (not formal), prevention and treatment of problems at an individual, group, organisational and community level. Psychologists and Clinical Psychologists must become registered with the Psychology Board of Australia to be able to practice as a “Psychologist” in NSW. There is a difference in the training of those who practice under the term “Psychologist” & “Clinical Psychologist”. They are as follows: Psychologists will have completed a 4-year Undergraduate degree in Psychology. They will have then undergone two years of supervised training by an accredited supervisor in order to become eligible for registration with the state board. A Clinical Psychologist is a person who in addition to their undergraduate training in Psychology, has completed post-graduate training in Clinical Psychology (Masters, Doctorate or PhD). During their post-graduate training they are taught theory, are closely supervised as interns, learn how to administer and interpret psychometric tests (i.e. intelligence testing, testing cognitive abilities) and undertake a research project. Social Workers assist individuals & communities with a variety of personal & social problems. They are trained to provide counselling, develop and implement social policy & and to assist various community groups. They must complete a Bachelor of Social Work (4 years)...

What should I expect from therapy?

Each session is usually 50-60 mins with the first appointment sometimes longer (e.g. up to 90 mins) as it takes time to gather information at the beginning of therapy. The number of sessions typically required varies depending on the individual. On average, between 12-18 sessions is a good upper estimate. Some of the factors that will affect the number of sessions required include severity and complexity of symptoms or issues and openness/willingness of the client to approach their issues and make changes. In terms of the experience of therapy, one thing I observe is that as a client becomes more aware of difficult thoughts and feelings, the harder it can be to continue with therapy. They often ask themselves why they would choose to feel the pain or discomfort of awareness! “Thinking about it and feeling the feelings makes it worse! I’m coming to therapy to feel better not worse!” Sometimes the only way to get to the other side is to go through the hard stuff! There are no short cuts, no way of avoiding the thoughts and feelings if you want to properly deal with the issues you struggle with. In terms of privacy & confidentiality, APS psychologists are bound by a Professional Code of Ethics. This is also typically in line with a code of ethics outlined by the state Registration Board. In summary, psychologists are required by their professional governing bodies to maintain confidentiality regarding information disclosed by a client and to ensure that their personal information is stored in such a way that their privacy is maintained. Confidentiality may be breached when there is...